Graduation Date

Fall 12-15-2023

Document Type

Dissertation

Degree Name

Doctor of Philosophy (PhD)

Programs

Medical Sciences Interdepartmental Area

First Advisor

David Dzewaltowski

Second Advisor

Michaela Schenkelberg

Third Advisor

Chris Wichman

Fourth Advisor

Amy Yaroch

Abstract

Indicators illuminating whole-of-community and setting system physical activity (PA) outcomes and drivers are needed to inform population health improvement efforts. This multi-study dissertation examines inequalities in PA resources, opportunities, and outcomes and the factors influencing inequalities across multiple temporal and geospatial scales (e.g., community, setting). First, a scoping review examined community-level variability in PA resource and opportunity availability by community sociodemographic characteristics (e.g., race). Across 46 included studies, 41 unique indicators characterizing community PA systems were identified, and 29.8% of relationships assessed indicated greater resource/opportunity availability in communities of higher socioeconomic status or lower minority population prevalence. The indicators synthesized in the review may be useful for understanding the physical and social conditions impacting PA. Secondly, the impact of community geographic, sociodemographic, and program and policy (CPP) characteristics on inequalities in the distribution of PA among youth was examined at a community level. The Gini coefficient, ranging from 0 (complete equality) to 1 (complete inequality), was used to quantify PA inequality. Findings illustrated geospatial variability in PA inequality across 130 communities (mean Gini=0.62, range=0.39–0.86). The effects of geographic and CPP characteristics on PA inequality were not significant (P>0.05). The effect of minority v status was significant (P=0.01), such that communities classified as African American had greater PA inequality. Thirdly, PA inequality, defined by the Gini coefficient, was examined in time-segmented organized group setting meetings (n=130) for children using video observation and accelerometer data from school classrooms, before-/after- school programs, and youth club groups. Within meeting routines, time segments with a purpose of organized PA had significantly lower inequality (P<.05) than other purpose types, such as academic and enrichment. Finally, PA inequality was examined during time-segmented youth sport practices (n=101). Time segments with a purpose of warm- up, fitness, and sport skill had significantly lower PA inequality (P<.05) than other purpose types (e.g., management). Community and setting system characteristics impact PA inequality among children. Indicators such as the Gini coefficient can illuminate inequalities in PA and may be useful for guiding efforts to improve population PA outcomes.

Comments

2023 Copyright, the authors

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